The last lab Newsletter of 2014

It's time for the last lab newsletter of 2014!

Some fun, some facts.

Merry Christmas from all of us at the lab, we look forward to seeing you all again in 2015

You can read the Newsletter by clicking the link below.

http://eepurl.com/_aX2D

Tips for getting the best from all ceramic restorations.

Getting the best from All Ceramic restorations

We love to share tips with our clients to help us work together to produce the best results we can for our patients.

This month we are going to share an important consideration when restoring with All Ceramic restorations, in particular we will be looking at the effects underlying stump shades have on the Value of all ceramic restorations.

Firstly, using an All Ceramic material offers the possibility of truly outstanding aesthetic results due to the lack of metal or reflective substructures, yet still offering very high strength. One of the reasons the results are superior is in the case of metal bonded (PFM) the frameworks are non-light transmittal, an aesthetic problem right from the start, plus as they are almost black in colour, and can be quite difficult to mask (which can often be the case with non translucent or ‘white’ Zirconia).

The main disadvantage of the Zirconia framework is the higher rate of chipping that can occur with the final layered ceramic. This can be due to many factors such as the critical material handling or if the frameworks have not been designed to support the layering porcelain in a very particular way.

So, with e.max press we have excellent strength when bonded as shown in this independent study.

These also offer superb choices of the pressed ceramic material to base the restoration which will provide a beautiful result.

Due to the translucency, one of the biggest factors involved in obtaining a successful result however is receiving adequate information regarding the shade of the preparation we are restoring upon.

As this is not normally a big factor with traditional restorations (due to the fact the substructure of alloy or zirconia will normally mask this) and it can easily be overlooked, the results of which will badly effect the Value of the crown and make it look dull and dead.

Here we look at the importance of communicating this information, and particularly how providing good photographs.

What do we need to use?

Digital Camera

It doesn't really matter what you're preferred brand is but a decent DSLR camera is essential for relaying accurate and genuinely useful detailed images to the lab.

We do get images from mobile devices and although some information is better than none at all, it really doesn't give us the depth of information needed to include the fine detailing that can really make a crown come to life and blend in naturally with the surrounding teeth.

Ivoclar Vivadent Natural Die (ND) shade guide

Ivoclar Vivadent shaded resins to match the ND shade guide.

Ivoclar Vivadent have created a range of ND shade guides for relaying the colour of the underlying preparation to the laboratory which can then use some special resins to pour the preps in the correct shade. This allows them to confirm that the different All Ceramic crowns or veneers match up even as they are building them and finishing at the laboratory.

At our laboratory we have taken this one step further by individually matching cement die spacers to each individual ND shade tab, this allows us to use the accurate model materials and systems we know get accurate results whilst also ensuring we have dealt with any shade correction issues properly.

And because we have different stones used for different indications we also matched each individual paint to give the same final shade regardless of which colour stone it is painted onto

Sounds like a lot of effort, how much of a difference does it really make?

If you look at the model we have painted to simulate the ND shades below you can see the variations on  the 15,14 & 13, with 15 & 14 being quite similar and the 13 being obviously more discoloured (a situation that occurs quite frequently on the cases we restore)

We pressed 3 simple blank veneers in e.max All Ceramic, each of an even thickness, and as you can see were all the same shade.

As you can see, these blanks aren't even that translucent so we have a potential issue even on LT pellets if the underlying shade is not taken into account.

As these are placed upon the different underlying stump shades you can see how it changes the veneer shade considerably.

This is more pronounced on the 13 but even shows on the 15 & 14 which had very little underlying shade variation

So we can see how making these veneers without the information regarding the shade of the stumps we were restoring on this would have been a disaster!

Although it is possible to use a range of coloured cements that Ivoclar provide to correct this, we believe it is always better to have the correct information to begin with and provide restorations to the surgeon which have already compensated for the underlying stump shade to keep your inconvenience to a minimum.

Case by Dr Gurs Sehmi

We are very fortunate to work with surgical partners who already provided us with this type of essential information even before we had the ND shade guides to assist us.

So in addition to providing us a clear photo with the desired shade tab included

In addition Dr Sehmi provided a shade of the underlying stump shades, which was very important in this case as it had a veneer and crown on 2 centrals, with a marked difference in the underlying tooth shade.

Dr. Sehmi used the shade guides he had available (the ND shade guides are not very well known, which in part is what prompted us to write this article) to relate the stump shades to us at the lab which we then used to paint the preps the correct colour, then by referring to a shade matching chart (available on page 58 & 59 of this pdf) we selected the appropriate e.max pellet to even up the e.max cores our ceramists would work on.

As all our ceramic team work with an iPad at their side which streams all the images you provide us with to them via a central media storage system. They always use these images and any others you send us, and any other information provided during the build of your restorations to ensure that all the vital characterisation is included.

We love getting these images to help us get the right results for you and your patients, so the more the better! 

By using all this information we managed to produce veneers which matched the smile even though we were compensating for different completely different shades underneath.

The patient was delighted with their new smile and we really appreciate it when you take the time to provide us with some of these crucial extra photographs that help us give your patients a great result.

By providing good photographs and including the stump shades it ensures both the laboratory and surgery are working from the same reference points.

Using this, even with really tricky underlying shades it is possible to get fantastic, natural looking e.max all ceramic restorations.

But without this vital information even the slightest difference can throw the final shade value off by enough to make the restoration stand out and look out of place.

By improving the communication and working to good photographs we can provide veneers like the ones you see below, which were used for BACD accreditation

Can you spot them?

Courtesy of Dr Donald Sloss

If you would like any more information on this or have any questions  then please call us on 

01765 607347 or email sean@ambridgeceramics.com

Thank You for helping us raise money for Save the Children

All the team in the lab would like to thank everyone for supporting our Christmas Jumper Day efforts in aid of Save the Children

It's got us all in the Christmas spirit a little early but the big question is, who's Christmas Jumper was the best?

Here's the candidates

We'll see you all again next year!!

Ambridge Ceramics Christmas 2014 Closure Dates

Talking of Christmas already!?

We just want to make sure that all our clients get plenty of notice so we can ensure no patients are left without their smiles for Christmas.

You can also download the pdf to print and put up on your wall by clicking the link below.

https://dl.dropboxusercontent.com/u/3248981/Christmas%20Closing%202014.pdf

Ambridge Ceramics continues to support The British Bite Mark

The Dental Laboratories Association are increasing their campaign of The British Bite Mark, a campaign that aims to raise public awareness of where their medical devices are made and as Ambridge Ceramics were one of the earliest members of the scheme we wanted to explain a little more about how we see The British Bite Mark benefitting the public and surgeons that choose to use a high quality lab.

The vast majority of the public are not aware of the different standards of traceability and skill required by each nation that produces dental restorations but in the UK the GDC and MHRA have gone to great lengths to ensure patient safety by demanding high levels of traceability, compliance, professionalism and a commitment to quality of care to patients from their members.

Because all this regulation has been laid out by these bodies solely to protect patients, it seems a good idea to ensure your restorations are made by technicians that have to be registered with and answer to these same bodies?

However there are a minority of dental restorations that leave the UK and this protective framework to be made in countries which do not have the same standards or traceability requirements, often without the knowledge of the patient who will have the medical device fitted.

This is not a simply case of trying to claim that work from one country is good and that from another is bad, but simply asking why the work is being sent offshore? If it is for economical reasons then is the patient fully aware of the option to have the work made within the protective framework setup by a skilled, GDC registered technician and what they are getting for their money?

Is the patient benefitting financially from the cheaper work being made by a lab in a country that is not regulated by the GDC or MHRA? or is the decision being made on their behalf and they are not being given the opportunity to make a choice between saving money or having the peace of mind knowing that their restorations were made by a skilled GDC registered professional?

The key to the whole issue is patient information and consent. If the patient is aware of all the information and still prefers to save money on their medical devices then that is fine, it's simply like the medical tourism which we have seen over the years.

However it's not maybe as obvious for that when many patients are unaware that their restorations were not made by a GDC registered technician within the protective system setup by the MHRA and GDC.

These people are unfortunately unwitting medical tourists who have not had the opportunity to be presented with the facts and weigh up the cost/benefits for themselves.

We live in a massive global economy and there is undoubtedly a benefit to using cheaper labour to keep production costs low, I think we are all aware that most of the technological devices etc. and many of the things we use every day are made this way?

But when we select medical devices and things we consume maybe we would make different choices if the fact were presented to us? The recent spate of health scares which have been reported in the media seems to indicate that some of the cost cutting in these areas has not been in the best interests of the consumers.

Although we don't agree with medical tourism (especially after seeing some of the shocking results that we have had to fix along with our skilled surgeons when some of these patients have come back to them after things have gone wrong) I can see why some people choose the apparent cost savings up front. However, I don't think it can ever be right that a patient becomes an accidental medical tourist because they are having restorations fitted that they are unaware have been made in an unregulated country.

At Ambridge Ceramics we have ploughed hundreds of thousand of pounds into new technology and technician training to continually improve the service we provide to our surgeons and patients, along with submitting to further voluntary independent inspection by a 3rd party assessor to ensure we meet the DAMAS standard ensuring we meet the highest possible levels of traceability and conformity on all our technician training and materials used.

Joining The British Bite Mark was just another logical step in our commitment at Ambridge Ceramics to providing our surgeons with the highest level of quality, traceability, service and support available in the UK, we passionately believe that the standards and skills required to work as a GDC registered technician in UK labs are among the highest in the world and the work that comes out of our lab is also among the best seen anywhere in the world.

If you are a surgeon that uses a British Bite Mark laboratory then please don't waste the opportunity to promote this to your patients, it's a mark of the commitment to excellent quality and service you provide. It may also help to explain to the patient why your service could be slightly more expensive than the practice down the road. Are they offering the same exceptional levels of quality and care?

You are offering a superior level of service, quality and traceability, so why not make that clear to the patient? Be proud to stand out and be known for focussing on offering the very best quality and service and peace of mind that you possibly can.

We have patient information booklets available that you can get by giving Sean a call on 01765 607347 or by contacting The Dental Laboratories Association directly by following this link

So when the campaign hits full swing and more patients start to ask "What's in my mouth?" you will be able to point to The British Bite Mark and demonstrate your commitment to offering restorations that are made in a lab, governed by the MHRA and produced by a GDC registered professional dental technician.

The Dental Laboratories Association have launched a dedicated British Bite Mark website that surgeons can use to find a laboratory but more importantly they have ensures that patients can find a surgeon that can supply them with these British Bite Mark restorations.

Please look at the site and ensure you are listed, this is something we have already started to do this for all clients of Ambridge Ceramics

Ambridge Ceramics fly the flag for Great British Dentistry and The British Bite Mark at EAO in Rome

Ambridge Ceramics fly the flag for Great British Dentistry and The British Bite Mark

The team at Ambridge Ceramics have been working together with our surgeons for over a year on the Pre launch for the official UK release of Dentsply Implants Atlantis porcelain fused to titanium screw retained crown units prior to their official launch at the end of 2014.

We are proud to confirm that some of this work will be presented at the EAO in Rome from the 25th to the 27th September 2014

The cases selected had the planning, implant placement and final crown delivery by both Dr Tim Doswell and Dr Kostas Papadopoulos and the laboratory stages were carried out by Lee Nichols & Steve campbell in the CAD design, then milled by Atlantis in Sweden. The ceramic crowns were made by both Mark Ambridge and Jack Gleave who layered these with Creation Ti ceramic. The composite layering was carried out by Iain Baldwin using the Visiolign system from Bredent.

These cases will be highlighting both the clinical and financial advantages of moving to these new implant crowns, regardless of which materia you choose to layer onto the biocompatible titanium crown abutment.

It's a great opportunity for us as a British Bite Mark laboratory to show the leading work that the UK dental profession can produce using the latest CADCAM technology and using the skills and knowledge of an experienced team

This early involvement with Dentsply implants has meant that clients of Ambridge Ceramics have been the first in the UK to offer their patients the benefits and proven aesthetics of porcelain fused to metal crowns but with the benefit of the substructure being titanium, which is proven to have higher biocompatibility than cast alloys or chrome.

As always, by using the latest CAD/CAM milling solutions we are able to ensure that not only are these crowns clinically superior to those previously available, they are also more cost effective, showing that when CADCAM technology is combined with the skill of the technicians in a British Bite Mark laboratory the results can be ideal for the patients.

There is still some confusion over how these modern techniques are more cost effective so we've tried to break it down below to show a comparisson of the old cast techniques vs. the new CADCAM milled titanium structures offered by Dentsply Atlantis.

The reason for the confusion is that traditional pricing is actually quite confusing. You need to combine all the lab costs, alloy and then the separate billing for the components needed to make the crown from the implant companies, and this bill will usually arrive separately from the work as it's ordered on your account and billed on the day the implant company sends it to the lab.

This leaves your admin team with alot of separate bills to tie up. Here's an example of the true cost of an traditional screw retained implant crown.

So when all the costs are combined, it's pretty expensive! And that is using either casting alloy or cast chrome, neither of which are as biocompatible as the titanium option Dentsply Atlantis crowns offer.

So here's how the costs break down on the new Atlantis titanium crowns

And we were deliberately conservative on the calculations of alloy required for the conventional screw retained crown in order to offer as fair a comparison as possible. The truth is that many cases are actually larger and this impacts the case costs considerably, as shown below.

In fact on average we save our clients around £140 per implant crown we restore using Dentsply Atlantis titanium Crowns, which can soon add up to alot of money saved a year. It's also a simple consistent cost regardless of your implant system, so you always know what the total cost of restoring your implants will be when quoting your patients.

Now you may not necessarily want to spend that saved £7000 on a watch, it was just an example of where your wasted money could have gone. But the key point is that this cost saving per implant quickly adds up to a substantial sum of money, which is better in your bank than the implant manufacturer and alloys companies.

As a British Bite Mark laboratory we are always pushing to ensure our clients get the very best in quality and service. Using the latest technology provided by proven industry leading partners we have continually shown that this doesn't have to cost you any more, in fact we have always brought a significant cost saving to our clients with all the CADCAM services we have developed at the lab.

The titanium screw retained crowns will be officially available to the UK late 2014 but we will continue to offer this and many other unique solutions to our clients up until their official launch date.

For more information or to order your screw retained implant crowns you can either contact us by email

sean@ambridgeceramics.com or Call Sean on 01765 607347

You can also download our labcards and postage labels directly from here and send your case into us.

Ambridge Ceramics produces dental implant stent for immediate loading technique published in Dental Practice Magazine

The team were fortunate enough to be asked to contribute their knowledge of Digital Dentistry and CAD/CAM restorations to a challenging case that Dr Mark Willings carried out using the immediate loading technique with his team at Dental Excellence Harewood.

It's always very satisfying to see such great result when working with new implant systems and techniques.

We've been working with the Dental Wings system for many years now to create digital scans of our implant cases, and it's a fantastic system that just gets better year on year.

You can read the full print article using the link below

https://www.dropbox.com/s/vm81oke26nnmicg/Gerald%20Crane%20case.pdf?dl=0